University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland.
Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
Sci Rep. 2019 Jan 30;9(1):954. doi: 10.1038/s41598-018-37533-3.
The aim of the present study was to assess the safety of microsurgical resection of intracranial tumors performed by supervised neurosurgical residents. We analyzed prospectively collected data from our institutional patient registry and dichotomized between procedures performed by supervised neurosurgery residents (defined as teaching procedures) or board-certified faculty neurosurgeons (defined as non-teaching procedures). The primary endpoint was morbidity at discharge, defined as a postoperative decrease of ≥10 points on the Karnofsky Performance Scale (KPS). Secondary endpoints included 3-month (M3) morbidity, mortality, the in-hospital complication rate, and complication type and severity. Of 1,446 consecutive procedures, 221 (15.3%) were teaching procedures. Patients in the teaching group were as likely as patients in the non-teaching group to experience discharge morbidity in both uni- (OR 0.85, 95%CI 0.60-1.22, p = 0.391) and multivariate analysis (adjusted OR 1.08, 95%CI 0.74-1.58, p = 0.680). The results were consistent at time of the M3 follow-up and in subgroup analyses. In-hospital mortality was equally low (0.24 vs. 0%, p = 0.461) and the likelihood (p = 0.499), type (p = 0.581) and severity of complications (p = 0.373) were similar. These results suggest that microsurgical resection of carefully selected intracranial tumors can be performed safely by supervised neurosurgical residents without increasing the risk of morbidity, mortality or perioperative complications. Appropriate allocation of operations according to case complexity and the resident's experience level, however, appears essential.
本研究旨在评估由监督神经外科住院医师进行的颅内肿瘤显微切除术的安全性。我们分析了从机构患者登记处收集的前瞻性数据，并将手术分为由监督神经外科住院医师（定义为教学手术）或经过董事会认证的神经外科教员（定义为非教学手术）进行的手术。主要终点是出院时的发病率，定义为术后卡诺夫斯基表现量表（KPS）下降≥10 分。次要终点包括 3 个月（M3）发病率、死亡率、住院期间并发症发生率以及并发症类型和严重程度。在 1446 例连续手术中，221 例（15.3%）为教学手术。在单变量和多变量分析中，教学组患者与非教学组患者在经历出院发病率方面的可能性相似（OR 0.85，95%CI 0.60-1.22，p=0.391）。M3 随访时和亚组分析的结果一致。住院死亡率同样较低（0.24%对 0%，p=0.461），并发症的可能性（p=0.499）、类型（p=0.581）和严重程度（p=0.373）相似。这些结果表明，在仔细选择的颅内肿瘤患者中，由监督神经外科住院医师进行的显微切除术可以安全进行，而不会增加发病率、死亡率或围手术期并发症的风险。然而，根据手术的复杂性和住院医师的经验水平适当分配手术似乎至关重要。
